Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male

Intraorbital foreign bodies are frequently the result of high-velocity injuries with varying clinical presentations. The resultant diagnosis, management, and outcome depend on the type of foreign body present, anatomical location, tissue disruption, and symptomatology. A patient who presented to the Emergency Department with a large intraorbital foreign body projectile that was not evident clinically, but found incidentally on computed tomography and subsequent plain films is reported. The emergency room physician needs to be aware of the differential diagnosis of a unilateral irregular pupil with or without visual acuity changes. The differential diagnosis for any trauma patient with an irregular pupil with significant visual loss must include intraorbital foreign body and associated injury to the optic nerve directly or via orbital compartment syndrome secondary to hemorrhage and/or edema. Patients with significantly decreased visual acuity may benefit from emergent surgical intervention. In patients with intact visual acuity, the patient must be monitored closely for any visual changes as this may require emergent surgical intervention.     

Acute myocardial infarction in a child with myocardial bridge

BACKGROUND:

Myocardial infarction (MI) is rare in children, and Kawasaki disease is now recognized as the main cause for MI. In this report, we present a child with MI caused by myocardial bridge (MB).

METHODS:

A 7.5-year-old boy was admitted to Weifang People’s Hospital on September 16, 2008 for heart disease. By electrocardiogram, coronary CT angiography, emission computed tomography, and other examinations, he was initially diagnosed as having (1) acute inferior myocardial infarction and extensive anterior myocardial infarction; (2) fulminant myocarditis; or (3) coronary myocardial bridge. He was treated with oxygen, thrombolysis, myocardial nutrition, vitamin C (4.0 g per time), dexamethasone (7.5 mg per time), a large dose of gamma globulin, and interferon.

RESULTS:

Myocardial enzymes, liver function, C-reactive protein, and troponin-I returned to normal at 21 days after treatment. At 29 days, electrocardiogram indicated that II, III, aVF, V4 - V6 leads had abnormal Q wave, and ST-T changed. The patient was discharged.

CONCLUSION:

Myocardial bridge may be one of the causes of MI in children.KEY WORDS: Myocardial bridge, Electrocardiogram, Acute myocardial infarction     

Acute myocardial infarction associated with albuterol

OBJECTIVE: To report a case of acute myocardial infarction (AMI) following the use of albuterol (salbutamol) in a patient without preexisting coronary artery disease and to review the related literature. CASE SUMMARY: An 84-year-old white woman with no history of cardiac disease was treated for an exacerbation of chronic obstructive pulmonary disease with albuterol 5 mg and ipratropium bromide 500 microg nebulized with oxygen; the albuterol was given in the same dose every 2 hours. Her respiratory condition improved, but soon after the sixth dose of albuterol, she developed increasing chest tightness. The electrocardiogram (ECG) showed ST segment elevation in the chest leads (V(2,3)) and, subsequently, the troponin I concentration and creatine kinase rose. Urgent coronary angiography showed smooth coronary arteries with no obstructive coronary artery disease or thrombosis. Left ventriculography showed anterior hypokinesia consistent with anterior myocardial injury. A subsequent echocardiogram also revealed normal left ventricular size but anterior, anteroseptal, and apical hypokinesia. An objective causality assessment revealed that albuterol had a probable likelihood of causing the AMI in this patient. DISCUSSION: A MEDLINE search (1966-February 2004) revealed 6 other case reports of AMI associated with albuterol treatment. The possible pathogenesis of albuterol-induced myocardial necrosis includes activation of cardiac and peripheral beta(2)-adrenoceptors, inducing positive chronotropic and inotropic effects and vasodilation with coronary blood flow redistribution. Albuterol can also cause hypokalemia and other metabolic and electrical changes, including prolonged QT interval. These effects may be especially detrimental in patients with hypoxia, hypercapnea, and preexisting heart diseases. CONCLUSIONS: Although myocardial injury is a rare complication following albuterol therapy, clinicians should use high-dose beta(2)-agonists with caution. Close monitoring of ECG and metabolic changes is recommended before early repeated high doses are administered.     

Acute myocardial infarction associated with amphetamine use

Myocardial infarction is a rarely reported complication of amphetamine use. We report the case of a healthy 31-year-old man who presented to our emergency department with no clinical evidence of an acute coronary event after intravenous injection of amphetamines. However, he subsequently experienced a non-Q-wave anterior wall myocardial infarction associated with the use of amphetamines.     

Acute myocardial infarction associated with initial cocaine use

We have described a young man who had acute myocardial infarction after his first use of cocaine. This case demonstrates that potentially lethal myocardial infarctions may be associated with such initial "experimentation" with cocaine even in relatively small doses. Cocaine intoxication should be considered in young patients with acute myocardial ischemia or necrosis. We recommend that cocaine metabolites be checked in the urine if a drug history is unreliable in such patients.     

右冠状动脉瘘并发心肌梗死1例

患者男,61岁.2年前患心肌梗死.心电图:广泛性前壁陈旧性心肌梗死.彩超检查:左室、左房轻度增大,左室前壁及前间隔室壁回声增强,左室前间隔及前壁中间段至心尖段运动消失,收缩期增厚率减低,收缩功能减低EF 39%.在大动脉短轴切面可观察到右冠状动脉破入右心房,彩色多普勒血流显示右冠状动脉内鲜亮的红色血流信号,瘘口处可见红色五彩血流从右冠状动脉至右心房(图1),瘘口内径2 mm,频谱多普勒显示双期连续高速射流,最高流速2 m/s(图2),右室压力45 mmHg.超声诊断:右冠状动脉瘘入右心房;缺血性心脏病(陈旧性心肌梗死)、左室收缩功能减低,肺动脉高压(轻度).     

冠状动脉左前降支心肌桥的320排CT形态学研究

目的本研究利用320排CT冠状动脉血管成像(CTCA)探讨心肌桥特征,重点研究左前降支心肌桥(MB)的形态学表现。方法本文回顾性分析了1693例患者的320排CTCA。21例患者由于图像质量差被排除在外。MB的长度和深度被记录,根据其与心肌束的部分包绕、完全包绕以及壁冠状动脉的深度分为不完全、浅表和深包埋型。结果这项研究包含的1672例患者中,505例患者被发现有516个MB(30.2%),488个MB位于LAD段(94.6%)。全部LAD段488个中不完全型202个(41.4%),浅表型165个(33.8%),深包埋型121个(24.8%)。不完全型、浅表型和深包埋型壁冠状动脉的平均长度分别为(6.6±5.3)mm、(13.9±4.5)mm和(25.4±4.1)mm。浅表型和深包埋型壁冠状动脉的平均深度分别为(0.4±0.4)mm和(2.5±1.3)mm。壁冠状动脉的直径大小平均(1.6±1.2)mm,壁冠状动脉近端冠状动脉直径平均(3.1±0.9)mm。MB近端2 cm内动脉粥样硬化斑块的发生率为105例(21.5%)。结论本文用320排CTCA描述了MB的发病率和形态学特征,重点研究了LAD心肌桥的形态...     

体表心电图对冠脉左主干病变患者短期预后的预测价值

目的评价冠脉左主干病变致急性心肌梗死住院患者短期预后体表心电图的预测价值。方法 41例接受再灌注治疗的冠脉左主干病变致急性心肌梗死住院患者均做全导心电图,讲心电图结果按存活组和死亡组分为两组。结果因冠脉左主干病变致心肌梗死的患者在30天的随访期中,有24例死亡,17例存活。死亡组中体表心电图aVR和aVL导联ST段均较存活组抬高(54%vs 18%,P<0.05),左前分支阻滞(83%vs 41%,P<0.05)和右束支阻滞(54%vs 18%,P<0.05)更常见,但V5导联ST段压低(17%vs59%,P<0.05)则少见。结论对因冠脉左主干病变致心肌梗死的住院患者,体表心电图对其短期预后预测有一定价值。     

Vasospastic myocardial infarction complicated with bilateral femoral arteries vasospasm

Coronary vasospasm is an infrequent cause of acute coronary syndrome. Additionally, femoral artery spasm is not frequently encountered clinically. Here we present a case of a patient with an acute ST segment elevation myocardial infarction, secondary to a documented right coronary artery vasospasm, complicated with left coronary artery and femoral artery vasospasm. Intravenous ultrasound showed calcification at the sites of spasm. This case report indicates that coronary vasospasm should be regularly considered as part of the work up of myocardial infarction.     

双源CT冠状动脉血管成像评价心肌桥与冠状动脉粥样硬化性病变的关系

目的：双源CT冠状动脉血管成像评价心肌桥与冠状动脉粥样硬化性病变的关系。材料与方法：对767例疑冠心病患者进行双源CT冠状动脉血管成像。计算心肌桥的发生率,测量心肌桥长度、深度、确切的部位及合并冠状动脉粥样硬化改变。比较单纯心肌桥组与合并冠状动脉硬化组之间的关系。结果：767例中,发现心肌桥-壁冠状动脉401例（52.3%）,左前降支是最常见的部位（344/401）,左前降支心肌桥组和无心肌桥组近侧冠状动脉粥样硬化比较,有显著统计学意义（P<0.0001）,其中轻度P<0.0001,中度P<0.02,重度P<0.0001。左前降支心肌桥近侧狭窄与心肌桥的厚度有关,与长度无关。结论：心肌桥近侧冠状动脉硬化发生率高,表明心肌桥是冠状动脉病变解剖学上的危险因素。     

双源CT冠状动脉造影心肌桥-壁冠状动脉的CT表现

目的：探讨双源CT（DSCT）冠状动脉造影对心肌桥-壁冠状动脉（MB-MCA）的检出率及其形态学特征。材料与方法：应用DSCT对470例患者行冠状动脉造影,测量MB的长度、厚度及MCA受压缩程度,用均数±标准差表示;观察记录MCA近段、远段邻近血管及MCA本身的形态变化。用Pearson等级相关检验、Wilcoxon秩和检验作统计学分析。结果：①MB-MCA检出率为27.9%（131/470）,MB平均长度为（20.8±9.0）mm,MB的平均厚度为（2.3±1.1）mm,MCA平均受压缩程度为（37.8±16.9）%;MCA受压缩程度与MB厚度呈正相关（r=0.60,P=0.000）,与MB的长度无相关性（r=0.21,P=0.540）。MB的厚度与MCA长度无相关性（r=0.18,P=0.101）。②62.7%（82例）MB-MCA桥前段或/和桥后段血管走行迂曲成角,且与MB的厚度相关（z=-3.15,P=0.002）,而与MB的长度无相关性（z=-0.41,P=0.967）。③67例MCA在收缩期呈圆锥状改变,舒张期这种改变明显减轻或消失。经统计学分析,MCA的这一表现与MB的厚度、长度均有相关性（z=-2.91,P＝0.004;z=-2.61,P＝0.009）。④46例MCA相邻的血管有动脉硬化征象,经统计学分析,MCA相邻血管有动脉硬化征象组与MB的厚度、长度均有相关性（z=-3.42,P＝0.001;z= -2.89,P＝0.004）。结论：DSCT可正确诊断MB-MCA的存在,并可判断MB-MCA的形态特征,为临床诊断和治疗提供了丰富的有价值的信息。     

Amphetamine-related acute myocardial infarction due to coronary artery spasm

A 27-year-old man developed acute myocardial infarction after intravenous amphetamine use. A coronary angiogram showed plaques in the mid-portion of the left anterior descending artery which developed coronary artery spasm after administration of intracoronary ergonovine. The findings in this case suggest that these coronary artery plaques played a role in the endothelial dysfunction resulting from amphetamine use, and that induction of coronary arterial spasm was the likely mechanism of amphetamine-related acute myocardial infarction.     

血清脂蛋白(a)与冠状动脉病变程度及心肌梗死的关系

目的:通过对不同类型冠心病患者血清脂蛋白(a)水平的分析,探讨血清脂蛋白(a)与冠状动脉病变严重程度及心肌梗死的关系.方法:行冠状动脉造影患者384例,根据临床诊断分为正常对照组、心绞痛组、心肌梗死组;根据冠状动脉病变支数分为正常对照组、单支病变组、双支病变组、3支病变组.分析各组血清脂蛋白(a)水平,并对血清脂蛋白(a)浓度及冠状动脉Gensini积分行相关分析.结果:单支病变组、双支病变组、3支病变组的血清脂蛋白(a)水平均明显高于对照组(P<0.05),但3组间比较差异无统计学意义(P>0.05);血清脂蛋白(a)水平与冠状动脉Gensini积分相关性分析显示二者呈正相关(相关系数r=0.378,P<0.01);心肌梗死组血清脂蛋白(a)水平明显高于心绞痛组(P<0.01).结论:血清脂蛋白(a)水平与冠状动脉病变程度呈正相关;血清脂蛋白(a)水平升高与心肌梗死的发生密切相关.